How to put trauma-informed care theory into practice

Trauma-informed care is an essential patient engagement framework to use with vulnerable or at-risk patient populations. Often, trauma and adverse childhood events (ACEs) contribute to the root causes of clinical and social comorbidities and interfere with attempts to support self-management. However, few provider organizations know how to design and implement an effective program. Providers can set patients up for long-term recovery with a model that centers programming on community input and provides expert-led and ongoing staff training.

1. Trauma recovery care should be integrated into clinical care—but community partners need to be incorporated, too

Community partners must be incorporated in trauma recovery care to inform tactics for violence prevention and follow-up social support. For example, community-based organizations that participate in street outreach and violence interruption have the greatest insight on neighborhood dynamics (e.g., times of day/week that violence is most likely to occur), victims of violence, and existing support (e.g., connection to immediate safe housing).

The University of Chicago's Violence Recovery Program offers immediate and long-term wraparound support for patients admitted to its trauma center. To design the program, hospital leaders formed a community advisory council consisting of 20 local leaders across the South side. A dedicated work group spent 18 months interviewing key stakeholders, including community-based organizations, the public health department, and national leaders in the field. The work group collected information on the root causes of community violence, existing violence prevention infrastructure, and behavioral health treatment best practices.

Community Care Partners of Greater Mecklenburg County is a care management organization that partners with Atrium Health, Novant Health, and other local providers. The coalition consults with a trauma-informed care expert to design staff training modules. At the outset, frontline staff were nervous about bringing up trauma with their patients for two reasons: 1) they felt unprepared to respond in the moment and meet patients' needs, and 2) they realized working with patients who have trauma is inherently traumatizing.

The expert consultant designed a staff training in collaboration with the in-house behavioral health coordinator. The goals of the training included understanding trauma, establishing a common language around trauma, developing tools for self-care, and outlining best practices for meeting patients' needs. The consultant holds trainings in phases to allow the material to be absorbed and avoid overwhelming staff. Staff learn:

Common presentations of trauma

Potential triggers

Effective interventions

Techniques to support resilience (e.g., mindfulness, meditation, and relationship-building skills)

Community resources for follow-up care

All staff participate in the training, including community health workers, care managers, psychiatrists, pharmacists, and the medical director. Self-identified trauma-informed care champions will renew best practices during all-staff meetings, commit to voicing concerns about how trauma impacts patient care during clinical huddles, and serve as an ongoing resource for colleagues.